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Case of the Month

September 2018

Patient Data: Two middle age female patients examined for SONOZORG a primary care ultrasound facility

Clinical Info: Both patients have a lump in the breast

Breast lesion in two patients Which of the lesions is malignant? A The right patient B The left patient C Both patients D None of the patients

The first patient had a large mainly cystic mass with solid parts

Another image of the same lesion

The solid part of the mass is vascularized and also part of the cyst wall.

Another image of the vascularized solid part.The lesion proved to be a squamus cell carcinoma. These carcinomas are rather unusual. No other primary squamus cell carcinoma was found so this proved to be a primary poorly differentiated squamus cell carcinoma.

This is an image from another patient with a vascularized intracystic mass. But this lesion proved to be a benign papilloma

This is the mass of the second patient. The mass has very irregular margins and spiculations

Another image of the mass without compression

The same mass with compression. The mass can be deformed.

The mass doesn't show any flow with color doppler

Another image with color doppler. Although the lesion looks malignant it has very little flow. It proved to be benign. The lesion was a sclerosing adenosis. These lesions are often indistinguishable from malignant lesions, as is the case with this patient.

This is an image of another patient with sclerosing adenosis

This is another patient with sclerosing adenosis

This is an other patient with a benign lesion (chronic inflammation) looking suspicious

Both lesions were classified as BIRADS 4(C) The first lesion could have been an intracystic papilloma, but also very well be a partly cystic malignant tumor. The mass was removed and proved to be a primary poorly differentiated squamus cell carcinoma. The lesion of the second patient proved to be benign sclerosing adenosis. It is known that sclerosing adenosis can mimic malignant lesions.
Lesions that can be malignant should always be classified as BIRADS 4 and biopsied or surgically removed

For more cases of intracystic carcinomas and benign lesions mimicking malignancy see

Copyright © Dr. T.S.A. Geertsma, Ziekenhuis Gelderse Vallei, Ede, The Netherlands. All rights reserved.

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